Rhode Island’s concept of healthcare may have come to a fork in the road with the possibility of a new free standing ER from Neighbors Emergency Center On Route 2, 325 Quaker Lane.

Neighbors, according to their website, was established by Dr. Setul Patel, CEO, in 2008. Since then, the company has expanded to 16 facilities throughout Texas and aims to open their first for Rhode Island on Route 2.

Patel, in a phone interview on Monday afternoon, said he and his partners created Neighbors in reaction to the experiences working in various traditional emergency rooms.

He said that they were “frustrated” that the patients weren’t “front and center” of the care provided. They saw freestanding ERs as their “avenue” to provide the care they wanted to see patients receive.

“If you take care of business and do it well, the patients will come,” he said.

Despite its claim to provide high quality facilities and care for patients in need of emergency services, many in the medical community question if it will provide any real benefit.

Neighbors is in the process of seeking a license for operations before the Health Services Council.

In an interview Monday morning, Michael Dacey, president and CEO, of Kent County Memorial Hospital, expressed concern that not only would a Neighbors facility provide less than adequate care for patients, but also as a for profit organization would impede improvements to healthcare reform.

Dacey has both testified and submitted letters in opposition of the center in the license hearings.

He said overall, the state is trying to reduce emergency room visits, encouraging patients to contact a physician or a primary care doctor when appropriate. The introduction of a new emergency care facility, “adds no benefit to the healthcare system. They actually do the opposite with discontinuous care that isn’t advantageous to a patient’s health.”

Dacey said the free standing ER “phenomenon” has been focused in the southern and western regions of the country, predominantly in Texas. The announcement for one of these organizations in Rhode Island caught many “by surprise. This all ran under the radar.”

Dacey explained that unlike Neighbors, if a hospital were looking to open a similar facility of its own accord, an auxiliary operation, it would have to receive a “certificate of need.” Since Neighbors does not, it can set up shop where there is no access issue.

Dacey said that moving forward they may seek to change amendments to the regulations requiring services like Neighbors to require a certification of need.

Kent sees more than 70,000 patients in the ER annually, and although Neighbors advertise shorter wait times than a traditional ER, the wait time for Kent averages from 16 to 19 minutes.

“You aren’t waiting hours like you may have before and our patient satisfaction is very high,” Dacey said.

Patel believes a lot of the opposition for Neighbors facilities come from a “lack of understanding” of what each center actually does.

“We are competition for them,” Patel said. “When we up the quality of care and standards they have to too. We are a competitive threat. We just want to give Rhode islanders a choice where right now they don’t have one.”

Dacey’s major concern, one he said is shared by a lot in the medical community, is that these organizations have “no dedication to the underserved” within their communities, whether that be to those with restricted access to medical assistance and or those struggling socio-economically.

“Warwick doesn’t have a problem with access,” Dacey said, “this isn’t a rural area, this isn’t an inner city. This is right near a hospital. They just hope to take the best paying patients with insurance to make a profit.”

Dacey pointed out, not only would the facility be less than 3 miles from the Kent, but it would not accept patients with Medicare or Medicaid, only those commercially insured patients.

He pointed out that many of the facilities in Texas are in similar areas, well-served suburban communities.

Similarly, although Warwick may not seem like an underserved community, said there is an overdose epidemic, and concerns with both substance abuse and behavioral health, issues Neighbors wouldn’t accept because these patients are typically considered to be on Medicare or Medicaid.

“These are not small numbers of people we are talking about and they want nothing to do with them,” Dacey said.

Patel argues that Neighbors are not allowed to accept Medicare or Medicaid because of federal stipulations, not because they don’t want to. Neighbors as well has other free standing ER corporations are lobbying congress to change that according to Patel.

He said the federal government has yet to catch up to the new medical phenomenon of free standing ERs, but they will be excited to accept those patients as well when and if regulations are amended. He believes it is a misrepresentation to say the centers do it by choice.

Neighbors markets itself as a full emergency room, and although they may have more high quality lab and imaging equipment than a typical walk-in facility, they are not backed by a hospital, and therefore would not have specialty doctors and surgeons available to a traditional ER Dacey pointed out. Although it was “unclear”, Dacey didn’t believe the center would take 9-1-1 patients and those more emergency cases coming through the door would be transferred to a hospital facility anyway.

“They are simply delaying care by marketing themselves as a full ER,” Dacey said. “So, they are a less capable service at the same price as the hospital and cherry picking only the best paying patients.”

For this reason many physicians and primary care doctors are also against a Neighbors facility because, “patients are cared for in a meaningful way,” Dacey said.

Patel would argue, their staff, uninhibited by larger numbers of patients, are allotted more time with each patient, giving time to help them understand not only what their diagnosis is, but also how and why they may have it.

“In our experience diagnosing the problem is only part of the job,” Patel said. “We can educate them on what is happening and the steps they can take.”

Dacey believes any organization that markets itself as an emergency room should have an obligation to take patients regardless of their ability to pay and treat any one patient in “their entirety”, not just the patients Neighbors can make a profit off of.

Technically, Dacey admitted, Neighbors isn’t doing anything illegal, but, “if they were trying to help an underserved community that otherwise may not have access that would be one thing, but the reality is these places sprout up in well served areas.”

Around 28 percent of Care New England patients receive Medicare or Medicaid and as such, Care New England hospitals, in the past fiscal year, has spent more than $25 million in “charity care”, $6.3 million from Kent Hospital services alone.

In comparison Dacey said Neighbors has no provision for free care.

Patel explained that although the line in the application does state $0 in charity care that is only referencing the money they collect for charity care, not how much would be spent for it.

He plans on presenting further data on Neighbors charity care in Texas and projections for Rhode Island at today’s meeting.

“I think our would-be competition is just concerned about their finances when we are concerned about patients,” he said.

“As a hospital, we take care of all our patients regardless of their ability to pay. We will find a way,” Dacey said. “But as a community we depend on hospitals and we need to be sustainable. This doesn’t seem fair or good.”

The licensing issue is before a subcommittee of the Health Services Council.

Today, deliberations will continue at 2:30 at the state administration building. The Council is expected to make a recommendation to the director of health who will decide whether to issue a license.